CA Billing & Coding – Psychotherapy Services | TMS Medical Billing , Psychiatric Billing Services

This guide explains psychotherapy billing and documentation for Medical so your practice can maximize reimbursement and reduce revenue leaks. If you need support with complex claims, including tms medical billing , psychiatric billing services, this article breaks down eligible providers, session types and CPT codes, medical necessity categories, documentation requirements, and key billing nuances to help mental health and psychiatry practices succeed.

Table of Contents

• Overview: who can bill and where to verify eligibility
• Psychotherapy session types and CPT codes
• Four Medi-Cal medical necessity categories that support psychotherapy
• Important billing nuances and add-on codes
• Shared rules across session types
• Grow a Thriving Psychiatry, Mental Health, or TMS Practice
• Practical next steps for practices
• FAQ

Overview: who can bill and where to verify eligibility

Medi-Cal recognizes licensed mental and behavioral health providers to furnish psychotherapy, including:

• Licensed clinical psychologists and psychologist assistants under clinical supervision
• Licensed marriage and family therapists and associates under supervision
• Licensed clinical social workers and associates under supervision
• Licensed professional clinical counselors and associates under supervision
• Psychiatrists, psychiatric physician assistants, and psychiatric nurse practitioners (with supervision where applicable)

Note clinic-type limits: RHCs and FQHCs may not reimburse services by associate or assistant providers or by certain licensed counselors and therapists. Always verify with Medi-Cal and private payers whether a practitioner type is covered at your location. Associate and assistant providers typically cannot bill independently and must be billed under a supervising clinician with documentation of direct clinical supervision (face-to-face weekly contact per California Board of Behavioral Sciences). Confirm acceptable methods for face-to-face contact with payers.

Psychotherapy session types and CPT codes

Medi-Cal reimburses four main psychotherapy session types. Below are the standard CPT codes and key timing rules to track when planning claims.

Individual psychotherapy

• 90832 — 30 minutes
• 90834 — 45 minutes
• 90837 — 60 minutes

Many coders rely on the CPT time rule (midpoint rule) to choose a time-based code for visits that do not precisely match the listed minutes. The CPT time rule allows reporting of the code if the service duration falls within a specified midpoint range. Medi-Cal has not universally confirmed adoption of the CPT time rule for all psychotherapy codes, so verify with Medi-Cal and commercial payers before applying the time rule to claims.

Family psychotherapy

• 90847 — family psychotherapy, patient present (typically 50 minutes)
• 90846 — family psychotherapy, patient not present

Family therapy focuses on family dynamics and their impact on the patient. Billing typically requires at least two family members present; check Medi-Cal for what qualifies as the two-family-member requirement. Medi-Cal limits reimbursement to a maximum number of minutes per day (for example, up to 110 minutes when the patient is present). Some clinic types may not be eligible to bill for sessions where the patient is absent.

Group psychotherapy

• 90853 — group psychotherapy (2 to 8 individual patients sharing issues)
• 90849 — multiple family group psychotherapy (patients and their families)

Medi-Cal advises that group sessions under 90 minutes are typically not reimbursable. Include start and stop times and the primary focus of the session in each participant’s chart. RHCs and FQHCs may have limits on billing group services; verify with payers.

Psychotherapy for crisis

• 90839 — crisis psychotherapy, first 60 minutes
• 90840 — add-on for each additional 30 minutes

Crisis psychotherapy is for patients presenting in acute distress, such as suicidality or disabling anxiety. When using crisis codes, document the clinician’s assessment that immediate attention was necessary, risk assessment, mobilization of resources, interventions used, and outcomes. Confirm telehealth allowances with payers since rules changed during the pandemic.

Four Medi-Cal medical necessity categories that support psychotherapy

Medi-Cal recognizes four distinct medical necessity categories that justify psychotherapy reimbursement. Each category affects allowable codes, diagnosis selection, and documentation details.

1. Treatment of a diagnosed mental health disorder or a developmental disorder of infancy and early childhood
2. Patients under 21 without a diagnosis but with approved risk factors in the child or parent/guardian
3. Patients presenting with persistent mental health symptoms in the absence of a formal diagnosis
4. Prevention of perinatal depression for pregnant and postpartum patients at risk

Key documentation and diagnosis rules

Documentation must be tailored to the medical necessity category. Minimum documentation elements common to most psychotherapy claims include:

• Signed, dated treatment plan with demographics, diagnosis (when present), treatment goals, measurable objectives, timeline, and number of sessions ordered by a referring PCP when applicable
• Symptom description, functional status, mental status exam, prognosis, progress toward goals
• Precise time spent providing the billable time-based psychotherapy service (do not include bundled activities such as chart review or care coordination in the therapy time)

When a patient is not diagnosed but meets risk-factor criteria, use diagnosis code Z71.89 (other specified counseling) to support medical necessity for patients under 21 with Medi-Cal-approved risk factors. For prevention of perinatal depression, use pregnancy/postpartum encounter codes (for example, Z34.* for pregnancy trimesters or Z39.2 for routine postpartum follow-up) and append modifier 33 to identify preventive services.

Important billing nuances and add-on codes

Below are high-impact billing nuances that affect reimbursement and coding accuracy.

Prolonged services (99354)

CPT 99354 reports prolonged face-to-face time beyond the usual service. Medi-Cal allows pairing 99354 with 90837 (60-minute individual) and 90847 (50-minute patient-present family therapy) in most medical necessity categories except prevention of perinatal depression. Medi-Cal has adopted a time calculation that lets you bill prolonged services per additional 30 minutes when using the CPT time rule. Verify time calculations with payers and document exact face-to-face minutes.

Interactive complexity (90785)

90785 is an add-on for visits complicated by specific communication or behavioral factors. This is not time-based. Only one qualifying factor needs to be present and documented, such as managing maladaptive communication, caregiver interference with treatment, newly discovered incidents (abuse/neglect) requiring reporting to third parties, or use of play/physical aids for patients with limited expressive or receptive language. 90785 is permitted with diagnostic evaluations and psychotherapy, but family psychotherapy and crisis psychotherapy are excluded from 90785 in some payer policies. Confirm applicability with Medi-Cal and other payers.

Shared rules across session types

• Psychotherapy delivered in primary care settings should be referred by the primary care physician, who indicates the initial number of sessions.
• Medi-Cal does not allow billing a psychiatric diagnostic evaluation and psychotherapy by the same provider on the same date of service for the same patient (avoid double billing).
• Crisis psychotherapy generally excludes billing for other psychotherapy services on the same date of service.

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Practical next steps for practices

• Confirm which clinician types your clinic can bill for with Medi-Cal and commercial payers.
• Create standardized templates for treatment plans, symptom tracking, start/stop times for group sessions, and crisis documentation.
• Decide whether to adopt the CPT time rule and document payer confirmation in your billing policies.
• Train staff on when to append modifier 33 for perinatal prevention services, and on the correct use of add-on codes 99354 and 90785.
• Consider outsourcing to a specialized partner for psychiatry medical billing, and tms medical billing, and psychiatric billing services to reduce denials and improve cash flow.

Frequently Asked Questions

Is there a Billing code for interactive complexity?

Yes, 90785 is an add-on code for interactive complexity. Use it when specified communication or behavioral factors complicate care. It is not time-based and requires documentation of the qualifying factor. Confirm exclusions with payers.